title: Management of cataract with macular oedema due to diabetes mellitus type-II and hypertension with grid laser prior to surgery and intra-vitreal bevacizumab (Avastin) peroperatively.
abstract: OBJECTIVE
  To study the visual outcome in patients subjected to cataract extraction with prior grid laser and intraoperative intravitreal bevacizumab injection.
  
  
  METHODS
  This prospective case series comprised of 38 patients subjected to phacoemulsification and in the bag intraocular lens implantation at Al-Noor Eye Hospital and Sindh Govt Lyari General Hospital Karachi from January 2007 to December 2008. All the patients had prior macular grid treatment and intra-operative injection of intra-vitreal Avastin. Diabetes mellitus duration, preoperative glycosylated haemoglobin (HbA1c) level and other systemic and local complications of diabetes were recorded. The patients were clinically assessed with biomicroscopic examination preoperatively, and postoperatively on day 1, week 1, and in months 1, 2, 3 and 6 respectively. Visual acuity and state of macular oedema was clinically assessed and documented.
  
  
  RESULTS
  Out of thirty-eight patients, eighteen were males and 20 were females. Mean duration of diabetes was 9.92 +/- 5.5 years (Range 4-16) while that of hypertension was 7.87 +/- 3.66 years (Range = 2-15). HbAlc level was 8.36% +/- 1.93% (range 6.3 - 12.3). Thirty-one (81.5%) patients had HbA1c level 8.0% or above indicating a poor control. At 6 months of follow up best corrected distant visual acuity of 6/6 to 6/9 was achieved in 23(60.5 %), 6/12 in 11(28.9%) and 6/24 in 4(10.5%) cases while best corrected near acuity of N/6 was achieved in 22 (57.8%) N/8 in 12 (31.4%) and N/12 in 4 (10.5%) cases. At 6 months follow up visual acuity declined in two cases because of uncontrolled diabetes and hypertension.
  
  
  CONCLUSIONS
  Cataract surgery in diabetic patients with macular oedema and hypertension has a good visual outcome if prior macular grid laser is performed and intra-vitreal anti VEGF is injected during surgery.
authors.affiliation: Department of Ophthalmology, Dow University of Health Sciences, Sindh Govt. Lyari General Hospital, Karachi.
authors.forename: Shahid
authors.initials: S
authors.lastname: Wahab
authors.forename: Jamshed
authors.initials: J
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage*; D000890:Anti-Infective Agents / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D002939:Ciprofloxacin / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003930:Diabetic Retinopathy / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000150:complications; D056965:Injections, Intraocular; D007429:Intraocular Pressure / Q000187:drug effects; D007430:Intraoperative Care; D017075:Laser Coagulation; D019654:Lens Implantation, Intraocular; D008269:Macular Edema / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification; D011446:Prospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity; D014822:Vitreous Body
chemical_list: D020533:Angiogenesis Inhibitors; D000890:Anti-Infective Agents; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D002939:Ciprofloxacin; D003907:Dexamethasone; D006442:Glycated Hemoglobin